How to unpickle an alcohol-soaked brain…

If you’ve consumed too much alcohol in the past years, it is possible to unpickle your brain – but there’s a catch.

Mild pickling can cause subtle impairments that can be difficult for you to recognise, probably because you are already slightly impaired.

To do something about this, you have to be clear headed enough to recognise you are not as sharp and as functional as you were and that you could benefit from real medical help.

A report from the United Kingdom suggests 80 per cent of people with alcohol-related brain damage, ARBD, are undiagnosed.

It says three quarters of them could be helped. “Usually a person’s intellect will recover over a period of three months of complete alcohol abstinence,” the authors say.

But for those who have drunk heavily over the long term, recovery could take up to three years. Then there are some who never regain what was lost.

The report, Alcohol and Brain Damage in Adults, is the result of a collaboration between the Royal College of Psychiatrists, the Royal College of Physicians, the Royal College of General Practitioners, and the Association of British Neurologists.

It says ARBD is not a defined diagnostic category. Rather, it is an umbrella term that covers a wide variety of conditions that affect the brain and the nervous system.

People who have it are typically active and in their 40s, 50s and 60s. They have structural and chemical changes in the areas of the brain that influence memory and executive function.

Men who consume an average of 50 standard drinks a week for five years are highly likely to have such changes.

But often these changes are not diagnosed because of a lack of awareness among health professionals and because of the stigma associated with long term alcohol misuse.

The report says as the intellect improves through abstinence and treatment, so do these changes, as visualised by scans.

MEDICATION MANAGED

The evidence shows optimal results can be achieved when withdrawal and the maintenance of withdrawal are managed with medication, together with ongoing counselling and support. Vitamins are often necessary too.While vitamin B1 has protective properties and is given during the acute phases of withdrawal, others are used to counter malnutrition which, in itself, can be damaging.

The report calls for a co-ordinated approach to managing ARBD.

Because there are no established pathways of care, it says people either receive no care or are directed to inappropriate care.

Some eventually land up in nursing homes designed for older people with dementia.

Providing specialist services for people with ARBD can make a dramatic improvement to their quality of life, says Kenneth Wilson, editor of the report and professor of old age psychiatry at the University of Liverpool. It can also dramatically reduce hospital admissions.

Australia doesn’t have a comprehensive approach either, says Dan Lubman, Director of Turning Point and Professor of Addiction Studies and Services at Monash University.

He says services are under-funded and treatment is episodic.

While a variety of services supply different forms of support to people with problematic drinking– including online and telephone services – , it is not always easy for a person to find a longer-term comprehensive package that offers both medical and psychological care, as exists for many other chronic medical conditions.

Although alcohol misuse can cause considerable bodily harm, Lubman says it is not often treated as a medical issue.

Rather, it has been seen as something that belongs in the domain of social welfare.

“We often fail to understand that alcohol is a drug that affects brain systems, which is why we take it,” says Lubman, who is also chair of the Royal Australian and New Zealand College of Psychiatrists’ Section of Addiction Psychiatry.

“Because it is licit, people fail to recognise it is toxic, particularly if consumed above recommended levels regularly, and can cause problems for both the body and brain.”

It is estimated 2.5 per cent of the general population of Australia would have some alcohol-related brain changes on post mortem. The degree ranges from mild to severe.

Among heavy drinkers, some 25 per cent would have noticeable changes on post mortem.

Lubman says that the best place to go for anyone concerned about their alcohol consumption is to their general practitioner.

If necessary, from there they can be referred on to an addiction medical specialist or to a specialist alcohol treatment service.

If concerned about confidentiality, one starting point could be to seek advice anonymously online from Turning Point at www.counsellingonline.org.au

Why your recognition of your impairment is impaired

JILL MARGO

A UK report says many people who have been drinking heavily for five years are unlikely to be aware of the effect this has had on their memory and their reasoning ability.

But their family, friends and employers are likely to have noticed.

These drinkers will probably also have ”furring” of their arteries in the brain which can lead to more permanent damage and can put them at risk of a stroke.

In general, their brains need up to three months of total abstinence to recover.

Recovery is much longer for serious long-term heavy drinkers. The changes in their brain are more permanent.

A major problem for them is getting enough vitamins. Even if they have good meals, many have problems absorbing vitamin B1 (thiamine). This and other vitamins are necessary for the brain to operate properly.

Without them brain damage can be permanent.

Typically, short-term memory has been affected. They appear able to maintain normal conversation but after a few minutes start to forget what has been discussed.

The same can happen to long-term memory and depending how seriously they are affected, they may lose up to 25 years’ worth of memories.

There is also a problem with false memories and when they can’t remember, they confabulate. Their brain tries to make sense of the world and fill in the gaps. They don’t recognise they are doing this.

Then there are problems with reasoning, difficulties with emotional issues and changes in behaviour.

They are unlikely to be aware that the front part of their brain, the main seat of reasoning and decision-making, is damaged.

This means they may not grasp the implications of decisions, particularly complicated ones in financial planning.

However, most can benefit from rehabilitation and dramatically improve over two to three years.

Others notice they have problems controlling impulses and managing risk. Socially they become unpredictable, they don’t comprehend the emotional needs of others and arguments or even relationship break-ups follow.